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Tylenol Flu (Daytime Relief) (Acetaminophen Dextromethorphan HBr Pseudoephedrine HCl)

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Pharmacology
Information not available

Indications
Analgesic Antipyretic Antitussive Decongestant

Contraindications
Known hypersensitivity to acetaminophen, pressor amines or other individual ingredients. Patients receiving or having received MAO inhibitors in the preceding 2weeks. Although pseudoephedrine is virtually without pressor effect in normotensive patients, it should be used with caution in hypertensives.

Safety Information / Warning
Information not available

Precautions
As with any other nonprescription analgesic drug, physicians should be cognisant of and supervise the use of acetaminophen in patients with alcoholism, serious kidney or serious liver disease. Chronic heavy alcohol abusers may be at increased risk of liver toxicity from excessive doses of acetaminophen, although reports of this event are rare. Reports usually involve cases of severe chronic alcoholics and the dosages of acetaminophen most often exceed recommended doses and often involve substantial overdose. Physicians should alert their patients who regularly consume large amounts of alcohol not to exceed the recommended doses of acetaminophen.

Patients should be counseled to consult a physician if redness or swelling is present in an area of pain, if symptoms do not improve or if they worsen, or if new symptoms such as high fever, rash, itching, excessive mucus, persistent or recurring cough or persistent headache occur, as these may be signs of a condition which requires medical attention.

Acetaminophen should not be taken for pain for more than 5days or for fever for more than 3days, unless directed by a physician.

Pregnancy  and Lactation:  As with any drug, patients who are pregnant or nursing a baby should consult a physician before taking this product.

Do not use with other products containing acetaminophen, salicylates or any other pain or fever medicine. Keep out of the reach of children.

In patients with high blood pressure, heart disease, diabetes, thyroid disease, difficulty in urination due to enlargement of the prostate gland or are taking a prescription drug for high blood pressure or depression, pseudoephedrine HCl should be used with caution and only under close medical supervision. Patients with asthma, glaucoma, emphysema, chronic pulmonary disease or shortness of breath should not use this medication unless directed by a physician.

This product should not be used for persistent or chronic cough such as occurs with smoking, asthma or emphysema unless directed by a physician.

Diphenhydramine has an atropine-like action and should be used with caution in patients with a history of bronchial asthma, increased intraocular pressure, hyperthyroidism, cardiovascular disease or hypertension.

Occupational Hazards: Preparations containing chlorpheniramine may cause drowsiness, preparations containing diphenhydramine may cause marked drowsiness, alcoholic beverages, sedatives and tranquilizers may increase this effect and should be avoided. Advise caution when driving a motor vehicle or operating machinery or engaging in any activity requiring alertness.

Patients taking tranquilizers or sedatives should not take this medication before consulting a physician.

Side Effects / Adverse Effects
The classic gastrointestinal irritation associated with nonsteroidal anti-inflammatory drugs, including ASA does not occur with acetaminophen. Sensitivity reactions are rare and may manifest as rash or urticaria. Cross-reactivity in ASA sensitive persons has been rarely reported. If sensitivity is suspected, discontinue use of the drug.

Patients who concomitantly medicate with warfarin-type anticoagulants and regular doses of acetaminophen have occasionally been reported to have unforeseen elevations in their INR. Physicians should be cognisant of this potential interaction and monitor the INR in such patients closely while therapy is established.

Drowsiness, dizziness, dryness of mouth, nausea and nervousness may occur with the use of diphenhydramine. Other infrequently reported effects include vertigo, palpitations, blurred vision, headache, restlessness, insomnia and thickening of bronchial secretions.

Diphenhydramine may cause excitability, especially in children.

Overdose
Symptoms and Treatment:  Acetaminophen: Typical Toxidrome: Significant overdoses of acetaminophen may result in potentially fatal hepatotoxicity. The physician should be mindful that there is no early presentation that is pathoneumonic for the overdose. A high degree of clinical suspicion must always be maintained.

Due to the wide availability of acetaminophen, it is commonly involved in single and mixed drug overdose situations and the practitioner should have a low threshold for screening for its presence in a patient's serum. Acute toxicity after single dose overdoses of acetaminophen can be anticipated when the overdose exceeds 150mg/kg. Chronic alcohol abusers, cachectic individuals, and persons taking pharmacologic inducers of the hepatic P450 microsomal enzyme system may be at risk with lower exposures.

There are been rare reports of chronic intoxication in persons consuming in excess of 150mg/kg of acetaminophen daily for several days.

Specific Antidote: NAC (N-acetylcysteine) administered by either the i.v. or the oral route is known to be a highly effective antidote for acetaminophen poisoning. It is most effective when administered within 8hours of a significant overdose but reports have indicated benefits to treatment initiated well beyond this time period. It is imperative to administer the antidote as early as possible in the time course of acute intoxication to reap the full benefits of the antidote's protective effects.

General Management: When the possibility of acetaminophen overdose exists, treatment should begin immediately and include appropriate decontamination of the gastrointestinal tract, proper supportive care, careful assessment of appropriately timed serum acetaminophen estimations evaluated against the Matthew-Rumack nomogram, timely administration of NAC as required and appropriate follow-up care. Physicians unfamiliar with the current management of acetaminophen overdose should consult with a Poison Control Centre immediately. Telephone numbers for local Poison Control Centres are available in the local phone directory. Delays in initiation of appropriate therapy may jeopardize the patient's chances for full recovery.

Pseudoephedrine HCl: Typical Toxidrome: sympathomimetic/stimulant. Specific Antidote: none. General Management: Stabilize the patient (A, B, C's), undertake appropriate gastrointestinal tract decontamination procedures, initiate supportive care, consult with a Regional Poison Control Centre regarding ongoing management, and arrange for appropriate follow-up care.

Diphenhydramine HCl: Typical Toxidrome: anticholinergic, CNS depressant (adult), CNS stimulant (child). Specific Antidote: none. General Management: Stabilize the patient (A, B, C's), undertake appropriate gastrointestinal tract decontamination procedures, initiate supportive care, consult with a Regional Poison Control Centre regarding ongoing management, and arrange for appropriate follow-up care.

Chlorpheniramine Maleate: Typical Toxidrome: anticholinergic, CNS depressant (adult), CNS stimulant (child). Specific Antidote: None. General Management: Stabilize the patient (A, B, Cs), undertake appropriate gastrointestinal tract decontamination procedures, initiate supportive care, consult with a Regional Poison Control Centre regarding ongoing management, and arrange for appropriate follow-up care.

Dextromethorphan HBr: Typical Toxidrome: narcotic/opiate. Specific Antidote: naloxone HCl. General Management: Stabilize the patient (A, B, Cs), undertake appropriate gastrointestinal tract decontamination procedures, initiate supportive care, administer antidote (see manufacturer's product monograph) as needed, consult with a Regional Poison Control Centre regarding ongoing management, and arrange for appropriate follow-up care.

Recommended Dosage
Flu Gelcaps: Adults (12 years of age and older): 1to 2gelcaps every 6to 8 hours as required. It is hazardous to exceed a combined total of any 8 Tylenol Flu gelcaps in a 24-hour period. Reduce dosage if nervousness or sleeplessness occurs.

Supplied / Packaging

 Flu Daytime Gelcaps:  Each solid capsule-shaped tablet, coated with white gelatin on one end and dark red gelatin on the other, with "Tylenol Flu" printed in grey, contains: acetaminophen 500mg, dextromethorphan HBr 15mg and pseudoephedrine HCl 30mg. Nonmedicinal ingredients: castor oil, cellulose, cornstarch, edetate calcium disodium, FD&C Blue No. 1, FD&C Red No. 40, gelatin, hydroxypropyl methylcellulose, iron black oxide, magnesium stearate, parabens, pharmaceutical glaze, propylene glycol, sodium hydroxide, sodium lauryl sulfate, sodium propionate, sodium starch glycolate and titanium dioxide. Energy: 1.5kJ (0.4kcal). Sodium: <1mmol ( 0.04mg). Gluten-, lactose-, sulfite-, sucrose- andfree. Blister packs of 10 and plastic bottles of 20†.

†Container provided with a child-resistant closure.

All packages are safety sealed.

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